Overnight-dwelled amino acid-based peritoneal dialysis solutions for malnutrition in CAPD: a prospective real-world study.

PURPOSE

To assess the efficacy and safety of amino acid peritoneal dialysis (AA-PD) in improving nutritional status among continuous ambulatory peritoneal dialysis (CAPD) patients with malnutrition in a real-world setting.

METHODS

A prospective self-control study was conducted across five hospitals in China. Patients aged 18-75 years with malnutrition [serum albumin < 35 g/L, prealbumin < 300 mg/L, or Subjective Global Assessment (SGA) score > 7] were enrolled. Each patient used one bag of 2 L 1.1% AA-PD solution to replace the 1.5% dextrose solution for the overnight dwell. All patients received routine nutritional management at their respective centers. Primary outcomes were changes in serum albumin and prealbumin levels. Secondary outcomes included SGA, normalized protein nitrogen appearance (nPCR, as a protein intake indicator), hand grip strength, mid-arm muscle circumference (MAMC), and body mass index (BMI). Clinical symptoms and adverse events were also monitored.

RESULTS

A total of 149 patients were enrolled, with 142 (95.3%) completing at least one efficacy assessment. After 6 months of AA-PD treatment, serum albumin increased from a baseline of 30.4-34.55 g/L (P < 0.001), and prealbumin increased from 302.8 to 348.7 mg/L (P < 0.001). SGA, nPCR, and hand grip strength improved significantly, while MAMC and BMI remained stable. The improvement in albumin level was independent of diet protein intake. Symptoms like anorexia, fatigue, and nausea decreased. A total of 53 patients (35.57%) experienced 56 treatment-emergent adverse events, of which only 3 mild events (2.01%) were considered related to AA-PD treatment. Additionally, 31 patients (20.81%) experienced a total of 31 serious adverse events, all of which were determined to be unrelated to AA-PD treatment. Although adverse events were generally mild with no AA-PD discontinuation, an acidosis tendency was noted.

CONCLUSION

AA-PD can improve serum levels of albumin and prealbumin, as well as clinical symptoms. However, relying solely on 6 months of AA-PD treatment is not sufficient to significantly improve medium- and long-term indicators. Treatment-related adverse reactions are generally mild, but acidosis still needs to be monitored.